كُتِبَت بتاريخ 31-01-2004 10:09 AM           IP: 212.138.47.11      

The war's over, but the suicide rate is high and the army is riddled with acute psychiatric problems. Peter Beaumont reports

Sunday January 25, 2004
The Observer

Up to one in five of the American military personnel in Iraq will suffer from post-traumatic stress disorder, say senior forces' medical staff dealing with the psychiatric fallout of the war.

This revelation follows the disclosure last month that more than 600 US servicemen and women have been evacuated from the country for psychiatric reasons since the conflict started last March.

At least 22 US soldiers have killed themselves - a rate considered abnormally high - mostly since President George Bush declared an end to major combat on 1 May last year, These suicides have led to a high-level Department of Defence investigation, details of which will be disclosed in the next few weeks.

Although the overall suicide rate is running at an average of 13.5 per 100,000 troops, compared with a US army average of 10.5 to 11 per 100,000 in recent years, the incidence of the vast majority of suicides in the period after 1 May is statistically significant, accounting for about 7 per cent of all service deaths in Iraq.

The same, say experts, is true for psychiatric evacuations, the majority of which have taken place after that date, a fact confirmed in recent interviews by Colonel Theodore Nam, chief of in-patient psychiatry services at the Walter Reed Army Medical Centre in Washington. He says no psychiatric cases at all were evacuated during the major combat. High levels of psychiatric casualties are expected, despite the US armed forces making an unprecedented effort to deal with stress and psychiatric disorders during service in Iraq.

At the heart of the concern is that Iraq may repeat the experience of Vietnam, which experienced low levels of psychiatric problems during service there in comparison with the two world wars, but very high levels of post-traumatic stress disorder (PTSD) among veterans later.

According to Captain Jennifer Berg, the chairman of psychiatric services at the Naval Medical Centre in San Diego, whose staff see US Marines returning from Iraq, military psychiatrists have been warned to expect the disorder to occur in 20 per cent of the servicemen and women in Iraq.

Although Berg believes some of the problems already reported - including the suicides and psychiatric evacuations - relate to people's experiences during the invasion rather than its aftermath, she concedes that the forces' present conditions of service in Iraq are producing their own problems.

'I think during the combat phase there was a huge outpouring of support at home. The soldiers were also trained and ramped up for their mission. There has been a change since then. There is a feeling among troops there that they have fallen off the public screen. And the longer people are there, the more we are seeing people come forward with stress reactions.'

Berg believes operating conditions for the 'nation-building phase' of the Iraq campaign are creating their own kinds of mental health problems - not least the ever-present threat to US vehicles and troops of the resistance's home-made mines. These are one of the main causes of death among coalition troops in the period after 1 May.

'In comparison with the combat phase, what we are now seeing are conditions of chronic stress which the troops are experiencing every day. It is a combination of danger, boredom and sleep deprivation, and the knowledge that they are a long way from home,' said Berg. 'In addition people are no longer sure when or what the end will be. No one knows when they will be going home. They are also working in an environment where the people they came to help are very hostile.'

Already the cases that such doctors as Berg are seeing have what she describes as 'classic reactions, the basic symptoms of combat stress'.

The psychiatrists have seen symptoms ranging from disturbed sleep, heart palpitations, nausea and diarrhoea to more obvious behavioural problems, such as forgetful-ness, aggression, irrational anger and feelings of alienation.

From the present period of chronic stress to the personnel, the doctors are expecting symptoms of depression and generalised anxiety to develop. These may be exacerbated by underlying existing traumas. The most pronounced cases have already ended in suicide.

Among them was Army Specialist Joseph Suell, who wrote a last letter home to his mother before he died of an overdose of the painkiller Tylenol on 16 June. Suell complained to her of the conditions he was living in, without electricity, water to bathe in, as well as a fear that he would be killed by an Iraqi sniper.

He complained how badly he missed his wife and daughters during a year-long posting to South Korea before he was sent to Kuwait and then on to Iraq. He had been granted compassionate leave.

As he prepared for war it was clear to his family he was in trouble, his worried wife even intervening to try to secure his return.

Suell's is one of the few suicides to have been reported in the American media. The Pentagon has refused to say which of its 'non-hostile fatalities' have been self-inflicted.

The military psychiatrists are puzzled by the suicide rate in Iraq, saying that it makes little sense in comparison with those in past conflicts.

The accepted wisdom in military psychiatry is that the level of suicides - far from increasing during wars - drops as the survival instinct kicks in among the personnel in the conflict zone. Just two suicides were recorded among US personnel during the entire Gulf war in the Nineties. What is also unusual about the rate in Iraq, in comparison with Vietnam, Korea and the Second World War, is that everyone serving in the all-volunteer forces has already been screened for their psychological suitability. They have also been briefed on combat stress and trained to counter any suicidal feelings, following a rash of military suicides which embarrassed the Pentagon in the late Nineties.

كُتِبَت بتاريخ 25-03-2004 09:55 AM           IP: 212.138.47.26      

لكنهم اضافوا ان فريق استشاريا للصحة العقلية للجيش يتألف من 12 اخصائيا لم
يعتبر ان معدل الانتحار بين الجنود الامريكيين في العراق يشكل أزمة.

وقال مسؤول كبير بالجيش وهو يعقب على التقرير قبل يوم من نشره رسميا "النتيجة
التي خلصوا اليها ان الامر لم يصل الى حد الوباء."

واعلن الجيش الامريكي ان 24 جنديا على الاقل انتحروا في العراق والكويت منذ بدء
الحرب على العراق في مارس اذار من العام الماضي. لكن مسؤولين قالوا انه منذ ان
انتحر خمسة جنود في يوليو تموز الماضي فان متوسط معدل الانتحار بلغ حوالي حالتي
انتحار في الشهر.

وفي الفترة من 1995 الى 2002 اعلن الجيش عن معدل انتحار بلغ 11.9 لكل 100
ألف جندي. وقال مسؤولون ان معدل الانتحار بين الجنود في الحرب في العراق بلغ
17.3 لكل مئة ألف في عام 2003 في حين ان المعدل العام بين صفوف الجيش بلغ
12.8 لكل مئة ألف في 2003 .

وقال المسؤول الكبير "احصاءات الجيش مرتفعة قليلا عن السنوات السابقة. لكنها ما
زالت اقل من المعدل القومي الامريكي في نفس المرحلة العمرية التي تتراوح بين 18
الى 30 عاما وهذا هو السبب في ان هذا لا يشكل ازمة."

وللولايات المتحدة حوالي 120 ألف جندي في العراق معظمهم من الجيش.

كُتِبَت بتاريخ 27-03-2004 11:45 AM           IP: 212.138.47.12      

Those are among the conclusions of a mental health assessment team that met with soldiers in Iraq and Kuwait between August and October last year, according to officials familiar with the results.

The Army planned to publicly announce the team's findings and recommendations on Thursday.

There were at least 24 suicides among U.S. soldiers in Iraq and Kuwait last year, according to the Army's count. That number may increase because the circumstances of some other deaths are still in doubt.

That equates to a suicide rate of 17.3 per 100,000 soldiers, compared with a rate of 12.8 for the entire Army in 2003 and an average rate of 11.9 for the Army during the 1995-2002 period, according to officials familiar with the mental health study. They spoke on condition of anonymity.

The 24 suicides do not include soldiers who killed themselves after returning to the United States.

Dr. Paul Ragan, an associate professor of psychiatry at Vanderbilt University and a former Navy psychiatrist, said in a telephone interview Thursday that 24 suicides among the soldiers in Iraq is "without question a highly statistically significant elevation of the number of suicides."

"This is a milestone," he said. "I think we need to have a major shift" in the Army's approach. "We're now past (asking), `Is there a problem?'" He said the Army needs to focus harder on understanding why soldiers kill themselves and finding more effective ways of preventing it.

The overall U.S. civilian suicide rate during 2001 was 10.7 per 100,000, according to the Centers for Disease Control and Prevention. The U.S. civilian rate for the 18-34 age group -- the age range of most soldiers -- is 21.5 per 100,000.

Investigators found common threads in the circumstances of the 24 soldiers who committed suicide. The soldiers were faced with personal financial problems, failed personal relationships and legal problems, officials said.

They also found -- as have previous Army probes of increases in the suicide rate during the 1990s -- that soldiers tend to avoid seeking help with stress or other mental health problems for fear of being stigmatized.

The team of Army mental health specialists surveyed about 750 soldiers in Iraq and Kuwait between August and October. It found that while stress was an issue, as might be expected in a combat zone, 77 percent described their stress as mild or minimal. Seven percent reported severe stress.

About 80 percent of those surveyed had been engaged in combat since their arrival in Iraq.

It is highly unusual for the Army to send a mental health assessment group to a war zone, but it did so after five soldiers committed suicide in July. That turned out to be a statistical spike because the number of suicides after July leveled off at about two per month.

July was a particularly difficult month for soldiers in Iraq. The combat phase of the war had ended in May and many soldiers thought the conflict was ending, but then an Iraqi insurgency took hold in June and July. Soldiers were being killed almost daily by roadside bombs and snipers.

The summer heat, combined with sometimes primitive living conditions for soldiers, added to the stress.

Among the mental health assessment team's recommendations:

--Refocus soldier training to improve the "buddy" system in which soldiers watch out for each other's well-being. The training would be aimed at allowing soldiers to more readily recognize signs of severe stress in their "buddy."

--Place more psychiatrists and other mental health professionals in Iraq and Kuwait so help is more accessible and can prevent soldiers in the early stages of mental crisis from becoming suicidal.

Dr. William Winkenwerder, assistant secretary of defense for health affairs, told reporters in January that of the more than 10,000 troops medically evacuated from Iraq, between 300 and 400 were sent outside the country for treatment of mental health problems.

The military prefers to treat mental health problems such as depression by keeping troops in their regular duties while they get counseling and possibly medication, Winkenwerder said. Less than 1 percent of the troops in Iraq are treated for mental issues during an average week, he said.

كُتِبَت بتاريخ 01-04-2004 11:12 AM           IP: 212.138.47.11      

The Army is requiring all soldiers to take a suicide prevention class within three months of arriving in Iraq or Kuwait, said Capt. Jeff Greenlinger, an Army mental health expert. Previously, soldiers had to take the class within a year.

The Army's four combat stress teams in Iraq have also begun closely monitoring suicide attempts and visiting U.S. military units that suffer deadly attacks, Greenlinger said.

"When we hear a unit has suffered any losses, say soldiers are wounded or killed in an attack, we're trying to get Combat Stress Control services to go out to them within a few days," said Greenlinger, of the 2nd Medical Brigade's mental health team. "We don't want to wait until it becomes a problem."

There were at least 23 suicides among U.S. soldiers in Iraq and Kuwait last year, according to the Army's count. That number may increase because there also are three deaths whose cause is still being investigated.

That equates to a suicide rate of 17.3 per 100,000 soldiers, compared with a rate of 12.8 for the entire Army in 2003 and an average rate of 11.9 for the Army during the 1995-2002 period, according to officials familiar with the mental health study. They spoke on condition of anonymity.

The 23 suicides do not include soldiers who killed themselves after returning to the United States.

The overall U.S. civilian suicide rate during 2001 was 10.7 per 100,000, according to the Centers for Disease Control and Prevention.

Two soldiers have killed themselves in 2004, according to the U.S. military. At that rate, soldiers appear to be taking their own lives less frequently than last year. Greenlinger said it is unclear whether prevention efforts or other factors are responsible for the drop.

Col. Bruce E. Crow, the chief psychologist at Madigan Army Medical Center at Fort Lewis, Wash., told reporters that there is very little historical data with which to compare the Iraq suicide statistics. The only wartime data the Army can find is a military-wide suicide rate for the Vietnam War that averaged 15.6 per 100,000 troops throughout the course of the war, and for the 1991 Gulf War a rate of 3.6 percent 100,000.

Col. Virgil J. Patterson III, who headed a 12-member Army mental health assessment team that visited Iraq and Kuwait between August and October last year, said their survey found that 50 percent of mental health providers reported a shortage of anti-depressant medications. The survey also found inadequate training for mental health providers and ill-defined standards of care.

The Army's efforts are the first time suicide counseling units have been stationed in a combat theater, Army Brig. Gen. Mark Kimmitt said Thursday.

"We typically see many solders who are crying out for help demonstrate suicidal (ideas) and we do what we can," Kimmitt told reporters.

He said soldiers are encouraged to keep an eye on their buddies and report signs of depression. Chaplains and commanders also watch for warning signs of suicide, Kimmitt said.

"I've seen as commander many times that a soldier will come up to their senior noncommissioned officers and say 'Hey sergeant, soldier X just isn't the same. He's drinking more than necessary and he's gotten very quiet and I know he's having some family problems,'" Kimmitt said.

When necessary, depressed troops are treated by four Army mental health units: the Army's 785th Combat Stress Control Company, and three combat stress control detachments.

The units have treated 2,008 soldiers, of whom 1,919 -- about 95 percent -- were sent back to duty, according to figures from the Army's 2nd Medical Brigade.

Some patients spend a few days or weeks away. Those sent home usually had existing mental health problems that were exacerbated by deployment, rather than combat stress, Greenlinger said.

The stress control units also conduct classes on conflict resolution, stress management and relaxation techniques.

Investigators found common threads in the circumstances of the suicides last year. The soldiers were faced with personal financial problems, failed personal relationships and legal problems, officials in Washington said.

Greenlinger said a possible reason for the drop in suicides was that the military has been notifying soldiers when their tours of duty end, instead of leaving the date open.

"When they know how long their deployment will be, that makes it a lot easier," he said.

Soldier suicides in Iraq are often reported as deaths by "non-hostile gunshot wound," leaving it unclear whether the death was self-inflicted or the result of an accident.

Copyright 2004 The Associated Press. All rights reserved

كُتِبَت بتاريخ 20-06-2004 10:35 PM           IP: 217.21.1.222      

هل هناك بيانات او ابحاث منشورة عن المواطنيين العراقيين وعن انتشار مثلا PTSD

وشكرا لكم على المعلومات مسبقا (ان توفرت لديكم)

فانا ارغب بمقارنتها بالناتئج الموجودة فى المجتمع الفلسطينى